Goto Kentaro, Matsusue Ryo, Degawa Kanako, Miki Akimori, Nakanishi Hiroki, Hata Hiroaki, Narita Masato, Yamaguchi Takashi
Department of Surgery, National Hospital Organisation Kyoto Medical Centre, Kyoto, Japan.
Division of Gastrointestinal Surgery, Department of Surgery, Kyoto University, Kyoto, Japan.
Surg Pract Sci. 2025 Feb 22;20:100277. doi: 10.1016/j.sipas.2025.100277. eCollection 2025 Mar.
Advances in minimally invasive surgeries and pre-operative treatments allow the preservation of anal function through lower anastomosis in patients with rectal cancer, often necessitating temporary diverting stomas owing to the risk of anastomotic leakage. Stoma closure is associated with a high rate of surgical site infections (SSIs). Various measures, including purse-string skin sutures and negative-pressure wound therapy, have been implemented, and some guidelines recommend purse-string skin sutures as the standard method of stoma closure. However, at our institution, we used linear skin closure with an SSI reduction bundle. This study describes our stoma closure method and retrospectively analyses surgical outcomes.
This retrospective study included patients aged ≥ 20 years who underwent loop stoma closure using linear skin sutures at our institution between January 2006 and March 2021. Our protocol emphasises the following: (1) pre-operative oral anti-microbials, (2) a surgical technique that distinctly separates clean and contaminated regions, and (3) wound closure to eliminate dead space. We evaluated the surgical outcomes, including the incidence of SSIs and other post-operative complications.
Ninety-two patients (53 men, 39 women; mean age, 59.4 years) underwent loop stoma closure. SSIs occurred in two patients (2.2%). No risk factors for SSIs were identified.
In our department, the incidence of SSIs after linear skin closure of stomas was low. Adherence to proper infection prevention practices can effectively mitigate SSIs, even with linear skin closure.
微创外科手术和术前治疗的进展使得直肠癌患者能够通过低位吻合术保留肛门功能，但由于吻合口漏的风险，通常需要临时造口转流。造口关闭与手术部位感染（SSI）的高发生率相关。已经采取了各种措施，包括荷包皮肤缝合和负压伤口治疗，一些指南推荐荷包皮肤缝合作为造口关闭的标准方法。然而，在我们机构，我们采用了带有SSI减少束的线性皮肤缝合。本研究描述了我们的造口关闭方法，并回顾性分析了手术结果。
这项回顾性研究纳入了2006年1月至2021年3月期间在我们机构接受线性皮肤缝合进行袢式造口关闭的年龄≥20岁的患者。我们的方案强调以下几点：（1）术前口服抗菌药物，（2）一种能明显区分清洁和污染区域的手术技术，（3）伤口缝合以消除死腔。我们评估了手术结果，包括SSI的发生率和其他术后并发症。
92例患者（53例男性，39例女性；平均年龄59.4岁）接受了袢式造口关闭。2例患者（2.2%）发生了SSI。未发现SSI的危险因素。
在我们科室，造口线性皮肤缝合术后SSI的发生率较低。即使采用线性皮肤缝合，坚持适当的感染预防措施也能有效减轻SSI。
